iFoster Technology Incident Report for Lost, Stolen, Broken Devices

iFoster Technology Incident Report
for Lost, Stolen, Broken Devices

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CA Foster Youth Phone Replacement request ONLY

The California Foster Youth LifeLine Program is now a permanent part of CA LifeLine and is administered by Maximus, effective 7/31/2024. You can reach Maximus at:
Phone: (833) 560-7477
Email: fostertpa@californialifeline.com

Website: www.californialifeline.com/foster

All other replacement requests

If your iFoster phone, laptop or tablet has been lost, stolen or broken please complete this form. iFoster will repair or replace any devices that have been lost, stolen or broken because of iFoster or its partners (i.e. device breaks in shipping). Devices that are lost, stolen or broken while in your ownership will require a review of your Incident Report. Based on this report, iFoster will recommend repair or replacement to its funders. Replacement is NOT automatic. A small fund for device replacement exists and is at the discretion of the funders of iFoster's technology programs. Please be as detailed as possible on your Incident Report so that iFoster can provide the best case for repair or replacement.

YOUTH APPLICANT INFORMATION

Contact Details

First Name

Last Name

Date of Birth (MM/DD/YY)

Phone

Device(s) with Issue

What device(s) are you having an issue with? (Select all that apply)

LaptopRevvl 4 Android PhoneRevvl 6 Android PhoneTablet

If the issue is with your iFoster phone, what is the phone number?

Date device was lost, stolen or broken (if not sure put date when you discovered the issue)

Location of Incident (i.e. coffeeshop, friend's home, school)

What is the issue with your device? (Go into more detail below)

LostStolenBrokenOther

Please write a detailed description of the circumstances that caused your device to become lost, stolen or broken. (i.e. arrived broken, lost when I went to the beach, broken by my roommate in an argument). Be as detailed as possible.

If your device is broken or not working properly describe, as best you can, what is wrong with it (i.e. my phone won't charge, my laptop screen is black). For lost or stolen mark, N/A.

If your device was stolen, did you file a police report? If yes, please upload a copy here. If no, please explain why not. If your device was not stolen, just mark N/A.

Upload Police Report for Stolen Device

What will you do differently going forward to ensure that you will do your best not to lose or break your device again? Please include an action plan (i.e. I will get a phone case, I will not leave my laptop unattended)

Shipping Address: If you are approved for a replacement device, we need a safe location to ship the replacement. Please provide a safe shipping location. We can ship it to an agency point person, directly to the youth or a supportive adult. For privacy purposes, we can not use a youth's name if shipping to a youth, so we will need a nickname or the name of a caregiver/supportive adult for the shipping label.

Nickname for Youth OR First and Last Name of Caregiver/Supportive Adult/Agency Point Person (person who device will be shipped to)

Email Address for Point Person (shipping tracking info will be sent here)

Phone Number for Point Person

Agency Shipping Address (Street Address)

Floor or Unit Number (n/a if none)

City

State

Postal Code

Thank you! We will review your Incident Report and get in touch with you with next steps. If a device is needed, we will need to seek approval from our funders for a replacement.

Questions?? - call, email or text us and one of our team members will be in touch asap:
Phone: 213-459-1128
Text: 213-459-1128
Email phone@ifoster.org

Contact Information